MEDICARE: YOUNG LIFE ASSISTED LIVING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL4043H	AZ

General Provider Information

NPI Number	:	1427595883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG LIFE ASSISTED LIVING INC.

Provider Business Mailing Address
First Line	:	1518 W ORANGEWOOD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7950
Country	:	US
Telephone Number	:	602-561-1285
Fax Number	:

Provider Business Practice Location Address
First Line	:	2742 W RANCHO DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-2644
Country	:	US
Telephone Number	:	602-595-3229
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	IONUT CALLINI
Credential	:
Telephone Number	:	602-561-1285

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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